Improving palatability of bowel prep

Ala Sharara, MD, from the American University of Beirut Medical Center in Beirut, Dr. Ala ShararaLebanon shares some insights about his Original Article “Sugar-free mentholyptus drops improve the palatability  and bowel cleansing effect of PEG-Electrolyte solution” from the December issue.

Colon preparations are generally poorly tolerated and, consequently, serve as an impediment to colorectal cancer screening and surveillance. An adequate bowel preparation is essential to optimal performance characteristics of colonoscopy. Despite a variety of small or large-volume cleansing solutions, 25-40% of patients have a suboptimal preparation. Split-dose 4L PEG-electrolyte solution (PEG-E) is a highly effective cleansing regimen but has important drawbacks with respect to taste and resultant nausea.

The aim of this randomized single-blind controlled trial was to investigate whether the simple addition of sugar-free menthol candy drops can improve the palatability and tolerability of split-dose 4L PEG-E. Ninety nine patients were enrolled: 49 received instructions to continuously suck on a commercially-available sugar-free menthol candy while consuming the PEG solution while 50 controls used the PEG-E without candy. Mean palatability score was significantly better in menthol users compared to controls. In addition, more preparations were scored as excellent according to the modified Aronchick scale (63.3% vs. 34% of controls). There was improved adherence with same-day volume of split-dose PEG-E in menthol users. Side effects were not different except for nausea which was considerably lower in the treatment arm.

Figure 2Quality of preparations according to the modified Aronchick scale. *P < .01.

This simple intervention may lead to considerable improvement in preparation quality, acceptability, and uptake with important effect on quality of optical colonoscopy. Further studies and real-life observations to support this simple concept are needed. It seems that “a spoonful” of sugar-free menthol does make the medicine go down!

Read this article on pages 886-891 of the print journal or find the abstract online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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